Democrats hailed the vote as historic, comparable to the establishment of Medicare and Social Security and a long overdue step forward in social justice. “This is the civil rights act of the 21st century,” said Representative James E. Clyburn of South Carolina, the No. 3 Democrat in the House.

We cannot afford to let this historic opportunity to restore the health and wholeness of families struggling to afford and access critical health care services pass us by. Turning back now will only lead to too many more years of denied care, higher numbers of uninsured, increasing health care costs, and lack of access to needed care.

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The Patient Protection and Affordable Care Act and the Reconciliation Act of 2010, which are expected to be signed into law by President Obama within days, will offer immediate benefits to millions of Americans through key provisions including:

1. SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)

2. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)

4. HELP FOR EARLY RETIREES—Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55-64. Effective 90 days after enactment.

5. ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.

6. NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)

8. BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)

9. FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS—Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment.

10. NEW, INDEPENDENT APPEALS PROCESS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.

11. ENSURING VALUE FOR PREMIUM PAYMENTS—Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.

12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)—Provides immediate access to affordable insurance for Americans who are uninsured because of a pre-existing condition – through a temporary subsidized high-risk pool. Effective 90 days after enactment.

13. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE – Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment.

14. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.

15. INCREASING NUMBER OF PRIMARY CARE DOCTORS—Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.

16. PROHIBITING DISCRIMINATION BASED ON SALARY—Prohibits group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.

17. HEALTH INSURANCE CONSUMER INFORMATION—Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in FY 2010.

18. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide home and community-based services to adults who become functionally disabled. Effective on January 1, 2011.

Peter Pearson

March 22, 2010

I followed the proceedings on CNN late into the night and was angered at the cynical manipulations and bullying tactics used by those who opposed this bill. That’s normal in politics but how can anyone invoke the concept of being pro-life and deny health care to millions? There’s a whole lot wrong with this government but thankfully they transcended lobbyists and big business long enough to serve the people in this instance.

Chris H.

March 22, 2010

Reform is definitely needed, but I get the feeling this is going to be a lot like credit card reform. In only a year they found ways to get their money around the rules. Insurance rates already go up so much every year that by 2014 those tax credits could be worthless. Health insurance companies are going to hike rates so high, my employer is going to decide paying the $2000 fine is cheaper and we can all go on Medicaid-since they’ve now allowed singles without kids onto the plan and raised how much you can earn and still be eligible. Nor have they figured out how to really pay for it. How convenient it doesn’t go into effect until the end of Obama’s second term.

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